LAPAROSCOPIC RESOLUTION OF A LEFT-SIDED STAB WOUND WITH DIAPHRAGM LESION - A CASE REPORT

Roxana Craciun; Vlad  Constantin; Alexandru  Carâp; Bogdan  Socea

doi:10.33695/rojes.v5i2.73

Roxana Craciun Saint Pantelimon Emergency Clinical Hospital
Vlad Constantin Surgery Department, Saint Pantelimon Emergency Clinical Hospital, Bucharest, Romania & Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Alexandru Carâp Surgery Department, Saint Pantelimon Emergency Clinical Hospital, Bucharest, Romania & Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Bogdan Socea Surgery Department, Saint Pantelimon Emergency Clinical Hospital, Bucharest, Romania & Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

DOI: https://doi.org/10.33695/rojes.v5i2.73

Keywords: diaphragmatic injury, minimally invasive surgery, trauma, penetrating wound, laparoscopic surgery

Abstract

Traumatic diaphragm injuries (TDI) are infrequent but can have profound implications for respiratory function. Penetrating chest trauma, particularly stab wounds, poses unique challenges due to small lesion sizes. The incidence of TDI, ranging from 1% to 8%, is higher in penetrating trauma. Left-sided diaphragmatic injuries predominate, potentially linked to assailants being predominantly right-handed. Imaging for TDI is challenging, with contrast-enhanced computed tomography being the gold standard, though limitations persist. We present a case of a 45-year-old woman with a left chest stab wound, illustrating the importance of timely diagnosis and intervention. Clinical presentation included pain on inspiration and signs of ethanol intoxication, but no signs of respiratory distress. Imaging revealed a diaphragmatic injury, prompting exploratory laparoscopy, confirming a two-centimeter laceration that was repaired with nonabsorbable sutures. No other incidents were reported during hospitalization.

TDI mortality rates vary (1%-30%), influenced by associated injuries. Minimally invasive approaches are recommended in stable patients, with thoracoscopy preferred. Prompt diagnosis and intervention are essential, given the risk of complications if treatment is delayed. This case underscores the importance of a high index of suspicion in penetrating chest trauma, ensuring rapid surgical intervention for improved patient outcomes.

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